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A man aged 72 reported haematuria in 1998. His medical history included silicosis due to dust exposure in uranium mines, for which he was receiving compensation. Urological examination revealed a transitional cell carcinoma of the bladder (pTa, G1). Six months later, splenomegaly was noted on routine ultrasound, and on removal the 647 g spleen was found to contain a highly malignant non-Hodgkin's B-cell lymphoma. A detailed occupational history was then taken because the man had worked from 1948 to 1952 in the former Wismut uranium mining company in Saxony, Germany, as a hewer. Working conditions were notoriously poor at the time1,2. The miner handled the explosive Donarit (contains dinitrotoluene, DNT), which for technical and economic reasons was used in the former German Democratic Republic instead of trinitrotoluene (TNT). As a miner, he had had to break the Donarit bars with his bare hands to obtain the required amount of explosive. He was therefore intensively exposed to the highly skin-penetrating DNT. ‘Dynamite headache’ is a commonly reported adverse effect of high occupational exposure to DNT. Dinitrotoluene is carcinogenic, because of metabolic transformation of the nitro groups to amino groups3. In human beings, aromatic amines are known carcinogens in the lower urinary tract4. Phenotyping of N-acetyltransferase 2 in the patient revealed a slow metabolizing capacity, a susceptibility factor for bladder cancer in those formerly exposed to aromatic amines5,6.
Multiple and different exposures may be relevant to occupational neoplasms. Therefore, at least in patients with bladder cancer, a detailed occupational history is needed from apprenticeship onwards. The likely cause of the neoplasm in this case—exposure to aromatic amines—would probably have gone unrecognized if the surgeons had not made a connection with the patient's occupational exposure to radioactive materials. An increased risk of non-Hodgkin's lymphoma in uranium miners has not been reported1,2.